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Government of Newfoundland Labrador

Service NL

Consumer Affairs Division

Complaint Record Information

Personal Company

Name: ___________________________

Address: _________________________

City/Town: _______________________

Postal Code: ______________________

Email:____________________________

Facsimile: ________________________

Phone (Home): ____________________

Phone (Work): ____________________

Signature: ________________________

Date: _____________________________

Name: ____________________________

Address: __________________________

City/Town: ________________________

Postal Code: _______________________

Fax or email: _______________________

Phone: ____________________________

Contact: ___________________________

Title: ______________________________

Description of Complaint

Description of Complaint (continued)

Desired Outcome or Objective

You may submit your complaint/enquiry by mail, with any pertinent information, to the

following address: Consumer Affairs Division

Service NL

Government of Newfoundland Labrador

P.O. Box 8700

149 Smallwood Drive

Mount Pearl, NL

A1B 4J6

Or you may also fax your complaint to 709-729-6998 or you may scan information and/or

email [email protected] . If you want to speak to us, you can call: 729-2600 /

729-2660 / Toll Free: 1-877-968-2600. By signing the following, you have consented to share

this document with the business in question, or other parties as necessary.

_____________________________/_____________________________Date____________________.

Please Print / Sign

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Personal information contained on this form is protected under The Access to Information and Protection of Privacy Act, 2015.
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